Provider Demographics
NPI:1790006369
Name:THAMES, SAGE AUSTIN (SAGE THAMES DDS)
Entity Type:Individual
Prefix:DR
First Name:SAGE
Middle Name:AUSTIN
Last Name:THAMES
Suffix:
Gender:M
Credentials:SAGE THAMES DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 ROUND ROCK AVE
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78681-4010
Mailing Address - Country:US
Mailing Address - Phone:512-733-5311
Mailing Address - Fax:
Practice Address - Street 1:2100 ROUND ROCK AVE
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78681-4010
Practice Address - Country:US
Practice Address - Phone:512-733-5311
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-18
Last Update Date:2021-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX255031223P0221X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No1223P0221XDental ProvidersDentistPediatric Dentistry